Category Archives: Cervical Cancer

How to protect your children from cancer – CDC

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Cancer Prevention Starts in Childhood

Tips from the US Centers for Disease Control and Prevention

Photo of two parents and three children sitting outside

You can reduce your children’s risk of getting cancer later in life.

Start by helping them adopt a healthy lifestyle with good eating habits and plenty of exercise to keep a healthy weight.

Then follow the tips below to help prevent specific kinds of cancer. Continue reading

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Women’s Health – Week 10: Cervical cancer and HPV

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Human Papilloma Virus

Human Papilloma Virus

From the Office of Research on Women’s Health

HPV is a virus that infects your genital region and can cause warts or even cancer. More than 30 types of genital human papillomavirus (HPV) can infect the genital areas of both women and men, including the vulva (area outside the vagina), anus, and the linings of the vagina, cervixrectum, and skin of the penis.

Most HPV infections go away on their own within a year or two. But persistent HPV infections are now recognized as the major cause of cervical cancer and other less common cancers, such as cancers of the vulva, vagina, anus, and penis.

Studies have also found that oral HPV infection is also a strong risk factor for oropharyngeal cancer (cancer of the throat and tongue).

Genital HPV infections are common and are passed from one person to another through sexual contact. The virus infects the skin and mucous membranes. Most people with HPV do not develop symptoms or health problems.

That is why it is very important for women to have regular Pap smear tests to screen for cervical cancer even if they have received an HPV vaccine. The Pap smear can identify abnormal or pre-cancerous changes in the cervix that a health care provider can remove before cancer develops.

HPV Vaccine
A vaccine can now protect females from the four types of HPV that cause most cervical cancers and genital warts. The vaccine is recommended for 11- and 12- year-old girls. It is also recommended for girls and women ages 13 to 26 who have not yet been vaccinated or completed the vaccine series. Vaccination against HPV is available also for boys and men, ages 9 to 26, for prevention of genital warts. Talk to your health care provider for more information.

The types of HPV that can cause cancer are not the same as the types that can cause genital warts. Genital warts usually appear as small bumps or groups of bumps. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh.

Warts may appear within weeks or months after sexual contact with an infected person or they may not appear at all (even if the person is infected with HPV). If left untreated, genital warts can go away, remain unchanged, or increase in size or number.

Protect yourself
Scientists have shown that condom use may protect you against HPV infection. Condom use has been associated with a lower rate of cervical cancer.

for more information: www.cancer.gov

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State gonorrhea cases up 34 percent

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Gonorrhea bacteria - Photo CDC

Gonorrhea bacteria – Photo CDC

From the Washington State Department of Health

The number of gonorrhea cases in Washington is up substantially this year compared to 2012. There have been 3,137 cases through September 2013 compared to 2,350 during the same time in 2012. That’s a 34 percent increase.

Rates have been going up steadily since 2010. Department of Health experts haven’t been able to attribute a specific cause to the uptick. The jump has occurred among men and women in most age groups, but young adults remain the most affected.

Rural and urban counties across Eastern and Western Washington have reported a climb in cases. However, several counties have seen more dramatic upswings, including Spokane, Yakima, Thurston, Kitsap and Benton counties, which are at outbreak levels.

Gonorrhea is the second most common sexually transmitted disease in Washington after chlamydia. It’s spread through unprotected sex with an infected partner. The infection often has no symptoms, particularly among women. If symptoms are present, they may include discharge or painful urination.

Serious long-term health issues can occur if the disease isn’t treated, including pelvic inflammatory disease, infertility and an increased likelihood of HIV transmission.

The department continues to monitor case reports. Local public health officials are actively working with health care providers to ensure that people with gonorrhea and those exposed get appropriate testing and treatment to stop ongoing spread of the disease.

“We’re working closely with local health agencies to actively monitor the rise in cases. We’re especially concerned because of gonorrhea’s resistance to antibiotics used to treat it,” said Mark Aubin, sexually transmitted disease controller for the Department of Health. “It’s important for us to assure every reported case is interviewed so the partners of infected people are identified and receive treatment.”

Despite the increase over the last couple years, Washington rates are still well below the national average.

Health officials urge anyone who is experiencing symptoms, or has a partner that has been diagnosed, to be tested. Routine screenings are recommended for sexually active people.

Prevention methods include consistent and correct use of condoms, partner treatment, mutual monogamy and abstinence.”

To learn more about gonorrhea and find out where you can get tested go to Public Health – Seattle & King County’s Sexually Transmitted Disease webpage.

 

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Washington teens getting their whooping cough immunizations; HPV vaccinations lag

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From the Washington State Department of Health

Vaccination_of_girlImmunization rates for Washington teens improved for some vaccines, while holding steady for others, according to a new national study.

In 2012, 86 percent of teens aged 13–17 in our state got a Tdap booster, according to the National Immunization Survey. That’s up from 75 percent in 2011 and tops the national goal of 80 percent.

Tdap is the vaccine that protects against tetanus, diphtheria and whooping cough (pertussis). The increase is welcome news following the recent whooping cough epidemic in Washington.

“We’re delighted that more teens in our state are protected against whooping cough,” said State Health Officer Dr. Maxine Hayes. “Older kids and teens often spread the disease to babies without knowing it. That’s why it’s so important for teens to get a dose of the Tdap vaccine.”

Over the last couple years, more teen girls are getting all three doses of the HPV vaccine, but fewer are getting the initial shot. About 43.5 percent of Washington girls 13 to 17 received the recommended three doses of the vaccine, up 3.5 percent from 2011.

Yet, only 64.5 percent of girls in the same age group got one dose of the HPV vaccine, a 2 percent decrease over the same time.

In 2012, nearly 15 percent of Washington boys aged 13–17 got the first HPV vaccine dose, up 6 percent from 2011. HPV vaccine was originally licensed only for girls and was made available to boys in October 2011.

This, plus a lack of knowledge by health care professionals and parents on the need and recommendation to vaccinate boys, may be why the rate for boys is lower than girls.

HPV vaccinations are recommended for girls and boys to protect against cervical cancer, genital warts and other types of oral and anal cancers.

Health care professionals should talk with parents about the importance of all kids getting HPV vaccinations starting at age 11 and 12. Kids in this age group have a stronger immune response compared to older kids.

“Parents want what’s best for their kids and want them to live happy, healthy lives,” Hayes said. “They can lower their children’s risk for HPV or cancer by getting them vaccinated.”

Nearly all sexually-active men and women will get at least one type of HPV at some point in their lives. HPV is most common in people in their teens and early 20s. That’s why it’s important for kids to get vaccinated before they start having sex. The vaccine doesn’t protect against any HPV strains someone already has.

Our state’s vaccination rate for two or more doses of chickenpox vaccine rose 8 percent in 2012. The rate for one dose of meningococcal vaccine rose slightly, from 69.4 percent in 2012 to 71.2 percent in 2011.

No-cost vaccines are available to kids up to 19-years-old through health care providers who participate in the state’s Childhood Vaccine Program.

Participating health care providers may charge for the office visit and an administration fee to give the vaccine. People who can’t afford the administration fee can ask for it to be waived.

For help finding a health care provider or an immunization clinic, call your local health agency or the WithinReach Family Health Hotline at 1-800-322-2588.

 

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Teens missing recommended vaccines, Seattle study finds

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HPV

HPV

By Sharyn Alden, HBNS Contributing Writer
Research Source: Journal of Adolescent Health

‘Health care providers are missing opportunities to improve teens’ vaccination coverage, reports a new study in the Journal of Adolescent Health.

Recommendations for routine vaccination of meningococcal (MCV), tetanus, diphtheria, and acellular pertussis (Tdap) and human papillomavirus (HPV) in adolescents are fairly new and many parents may be unaware of the need for adolescent vaccines.

“Our study found that when adolescents who are vaccine-eligible come to their health care provider for preventive visits, there are missed opportunities for vaccination. Adolescents who come in for non-preventive visits have even greater missed opportunities,” said lead author Rachel A. Katzenellenbogen, M.D., assistant professor of pediatrics at the University of Washington and Seattle Children’s Hospital.

“Our data found that adolescents who have an appointment come into their health care provider’s office and leave without receiving all three recommended vaccines—Tdap, HPV and MCV,” Katzenellenbogen said.

Adolescents need fewer preventive care visits than infants and are a relatively new population to be targeted for vaccination when compared to infants and children, she explained.

Katzenellenbogen and her colleagues analyzed vaccination rates for 1,628 adolescents aged 11- 18 with 9,180 visits to health care providers between 2006 and 2011.

All of the teens in the study were seen at a pediatric clinic in Seattle. During that time frame, 82 percent missed being vaccinated against MCV, 85 percent missed Tdap and 82 percent missed the first dose of HPV1.

“If parents know to expect that their adolescent should receive three vaccines when they turn 11 or 12, they may be more likely to schedule a preventive visit or bring up vaccination with their child’s health care provider during any office visit,” commented Kristen A. Feemster, M.D., assistant professor in the division of infectious diseases at the University of Pennsylvania School of Medicine.

Feemster said she was not surprised that missed opportunities occur because there are many challenges to implanting adolescent vaccine recommendations. “It is more challenging, for example, to establish eligibility for adolescent vaccines—many registries do not yet reliably capture adolescent vaccination.  Providers may have questions or concerns about the recommended schedule, plus adolescents may seek care in alternative locations where it is particularly difficult to establish eligibility.”

The researchers suggest that improved vaccine tracking and screening systems, such as provider prompts through electronic health records or manual flags by nurses or medical assistants, would enable providers to more easily identify those teenagers eligible for vaccines at all visit types.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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CA

U.S. cancer deaths continue long-term decline

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By Bill Robinson
NCI Cancer Bulletin

According to the latest national data, overall death rates from cancer declined from 2000 through 2009 in the United States, maintaining a trend seen since the early 1990s.

SR-inside

Mortality fell for most cancer types, including the four most common types of cancer in the United States (lungcolon and rectumbreast, and prostate), although the trend varied by cancer type and across racial and ethnic groups.

The complete “Annual Report to the Nation on the Status of Cancer, 1975–2009″ appeared January 7 in the Journal of the National Cancer Institute.

The report also includes a special section on cancers associated with the human papillomavirus (HPV) that shows that, from 2008 through 2010, incidence rates rose for HPV-associated oropharyngealanal, and vulvar cancers.

HPV vaccination rates in 2010 remained low among the target population of adolescent girls in the United States.

As in past years, NCI, the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), and the North American Association of Central Cancer Registries (NAACCR) collaborated on the annual report.

Cancer incidence data came from NCI’s Surveillance, Epidemiology, and End Results (SEER) database and the CDC, with analyses of pooled data by NAACCR. Mortality data came from the CDC’s National Center for Health Statistics.

Incidence Rates Vary, Death Rates Continue to Drop

Among men, the overall rate of cancer incidence fell by an average of 0.6 percent annually from 2000 through 2009. Cancer incidence rates were stable among women during the same time period and rose by 0.6 percent per year among children. (See the table.)

“The continuing drop in cancer mortality over the past two decades is reason to cheer . . . The challenge we now face is how to continue those gains in the face of new obstacles, like obesity and HPV infections.”

The declines in cancer mortality averaged 1.8 percent per year for men, 1.4 percent per year for women, and 1.8 percent for children (ages 0 to 14 years) from 2000 through 2009.

During the same period, death rates among men fell for 10 of the 17 most common cancers and rose for three types of cancer. Death rates among women fell for 15 of the 18 most common cancers and also rose for three types of cancer.

“The continuing drop in cancer mortality over the past two decades is reason to cheer,” said ACS Chief Executive Officer Dr. John R. Seffrin in a statement. “The challenge we now face is how to continue those gains in the face of new obstacles, like obesity and HPV infections. We must face these hurdles head on, without distraction, and without delay, by expanding access to proven strategies to prevent and control cancer.”

HPV Vaccination Rates Low

The special section on HPV-related cancers showed that from 2000 through 2009, incidence rates for HPV-associated oropharyngeal cancer increased among white men and women, as did rates for anal cancer among white and black men and women. Incidence rates for cancer of the vulva also increased among white and black women.

However, cervical cancer rates declined among all women except American Indian/Alaska Natives. In addition, cervical cancer incidence rates were higher among women living in lower-income areas.

The annual report also showed that, in 2010, fewer than half (48.7 percent) of girls ages 13 through 17 had received at least one dose of the HPV vaccine, and only 32 percent had received all three recommended doses, a rate that fell well short of the Department of Health and Human Services’ Healthy People 2020 target of 80 percent.

The rate is also much lower than vaccination rates reported in Canada (50 to 85 percent) and the United Kingdom and Australia (both higher than 70 percent).

Vaccination series completion rates were generally lower among certain populations, including girls living in the South, those living below the poverty level, and Hispanics.

“The influence that certain viral infections can have on cancer rates is significant and continued attention to the effect[s] of HPV infection, in particular, on cervical cancer rates is critical,” said NCI Director Dr. Harold Varmus in a statement. “It is important, however, to note that the investments we have made in HPV research can only have the tremendous payoff of which they are capable if vaccination rates … increase.”

Cancer Incidence and Mortality Rates, 2000–2009

Men Women
Incidence Increase

  • kidney
  • pancreas
  • liver
  • thyroid
  • melanoma
  • myeloma

Decrease

  • prostate
  • lung
  • colorectal
  • stomach
  • larynx
Increase

  • thyroid
  • melanoma
  • kidney
  • pancreas
  • leukemia
  • liver
  • corpus and uterus

Decrease

  • lung
  • colorectal
  • bladder
  • cervix
  • oral cavity and pharynx
  • ovary
  • stomach
Mortality Increase

  • melanoma
  • liver
  • pancreas

Decrease

  • lung
  • prostate
  • colon and rectum
  • non-Hodgkin lymphoma
  • kidney
  • stomach
  • myeloma
  • oral cavity and pharynx
  • larynx
  • leukemia
Increase

  • pancreas
  • liver
  • corpus and uterus

Decrease

  • lung
  • breast
  • colon and rectum
  • leukemia
  • non-Hodgkin lymphoma
  • brain and other nervous system
  • myeloma
  • kidney
  • stomach
  • cervix
  • bladder
  • esophagus
  • oral cavity and pharynx
  • ovary
  • gallbladder

The NCI Cancer Bulletin is an award-winning biweekly online newsletter designed to provide useful, timely information about cancer research to the cancer community. The newsletter is published approximately 24 times per year by the National Cancer Institute (NCI), with day-to-day operational oversight conducted by federal and contract staff in the NCI Office of Communications and Education. The material is entirely in the public domain and can be repurposed or reproduced without permission. Citation of the source is appreciated.

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Ouch! Child gets a shot.

State’s teen immunization rates a “mixed bag”, say Washington health officials

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Ouch! Child gets a shot.Immunization rates among teens in Washington appear to be improving for some vaccines, while holding steady or dropping slightly for others, according to the 2011 National Immunization Survey that has just been released.

Although more teens 13–17 years of age are vaccinated against serious diseases than in previous years, teen immunization rates remain below state goals, Washington state health officials said.

“Some diseases, such as chickenpox, are more dangerous for older teens than for younger kids,” said Secretary of Health MarynSelecky. “Missing or delaying even one vaccine puts them at risk for catching and spreading disease. Parents should get their teenagers immunized when the teen sees a health care provider for sports physicals, injuries, or mild illnesses.”

Even with some gains in teen immunization rates, the survey shows that Washington is not meeting state and national vaccination goals, state health officials said.

Those goals include vaccinating 90 percent of teens with the vaccine that protects against chickenpox (varicella) and 80 percent coverage against whooping cough (pertussis), human papillomavirus (HPV), and meningococcal disease.

“The whooping cough epidemic reminds us that it’s vital for teens to get immunized on time,” said  Selecky. “Immunizing teens is as important as immunizing young children – it protects the teens and everyone around them, especially babies who are too young for vaccination. Every teen should be up-to-date with all recommended vaccines.”

The percentage of teens getting the whooping cough vaccine, Tdap, improved from 71 percent in 2010 to 75 percent in 2011; the national average is 78 percent.

Washington state is in the midst of the worst whooping cough epidemic in 70 years with nearly 3,800 cases reported so far this year

Whooping cough vaccines are recommended for all kids, teens, and adults.

Most people get a series of whooping cough vaccines as kids, but protection wears off over time. That’s why a dose of Tdap is recommended for everyone age 11 and older. Booster shots play a key role in the fight against diseases that vaccines can prevent.

State’s HPV vaccine rate on of the nation’s highest.

Washington state continues to have one of the highest first-dose HPV vaccination rates for females in the nation; however, the estimated rate decreased from 69 percent to 67 percent and only 40 percent of teen girls got all three doses needed to be fully protected.

For the first time, the national survey included HPV vaccination rates for males; 9 percent got one dose of the vaccine compared to the national average of 8 percent.

State health officials are urging health-care providers to talk with parents about the importance of all children getting the HPV vaccine at age 11-12. Children in this age group have a stronger immune response compared to older ages.

All recommended vaccines are offered at no-cost for children up to age 19 in Washington through healthcare providers participating in the state’s Childhood Vaccine Program.

Some providers may charge for an office visit and/or a fee to give the vaccinations (called an administration fee). People who can’t afford the administration fee can ask the health care provider to waive the cost.

For help finding a health care provider or an immunization clinic call the local health agency in your area or the Family Health Hotline, 1-800-322-2588.

More information on immunizations is on the Department of Health Office of Immunization and Child Profile website (doh.wa.gov/cfh/Immunize). The National Immunization Survey (cdc.gov/nis/) is available from the Centers for Disease Control and Prevention.

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HPV

What you need to know about HPV

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By Monica Richter, MD, PhD

One of the most important recent advances in women’s health is a vaccine against human papillomavirus (HPV). The HPV vaccine protects against serious health problems such as cervical cancer and other less common cancers.

The first HPV vaccine was approved in June of 2006 after testing in thousands of people around the world.

Two HPV vaccines are currently licensed by the FDA and recommended by the Centers for Disease Control and Prevention (CDC): Gardacil is approved for girls or boys ages 9 to 26, and Cervarix is approved for girls 10 through 25 years of age.

HPV is the most common sexually transmitted virus in the United States. More than half of sexually active men and women are infected with the virus at some time in their lives.

In addition to causing cervical cancer, HPV can cause vaginal and vulvar cancer in women, and other types of cancers in both men and women. It can also cause genital warts and warts in the throat.

But good news! The HPV vaccine can prevent most cases of cervical cancer in women. It can also prevent vaginal and vulvar cancer in women and genital warts and anal cancer in both men and women. Protection from the vaccine is long-lasting.

While we all hope that young teens are abstaining from sexual activity, it is important to vaccinate girls long before their first sexual contact.

In addition, the response to the vaccine is stronger in younger girls and for this reason, we recommend vaccinating girls at age 11 or 12 years. The vaccine is given as a 3-dose series over 6 months.

Both vaccines are available for women, but only one of them can be given to men also.

Vaccines have undergone a lot of scrutiny in recent years, but all of the available scientific evidence confirms their safety and efficacy.

In spite of this, many false rumors are circulating and I continue to be confused by the number of parents who decline the vaccine for their daughters. As a mother and a pediatrician,

I gave my daughter the HPV vaccine as soon as it became available and I urge all parents to do the same.

For more information on the HPV vaccine, visit www.cdc.gov/vaccines.

About Monica Richter, MD, PhD

Dr. Monica Richter is a board certified pediatrician with Valley Children’s Clinic. Over the past 18+ years Dr. Richter has helped hundreds of pubescent girls navigate the physical and emotional aspects of their changing bodies and psyches, including menstruation, body changes, sexuality and how babies are conceived, through her free seminar, As Girls Grow Up. She also teaches BodyWorks, an eight-week health education program developed by the Dept. of Health & Human Services. Bodyworks is designed to provide parents and caregivers of teenage girls and boys ages 9 to 16 with tools to improve family eating and activity habits. Originally from Manhattan, Dr. Richter is married with two grown children. In her spare time she enjoys reading and knitting.

Valley Children’s Clinic is located at 4011 Talbot Road S., Suite 220, in Renton. Phone: 425.656.5300; www.valleychildrensclinic.org

 

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Gilda's Club Seattle Logo

You’ve been treated for cancer — now what?

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Treatment Summaries and Surviorship Care Planning

What do you do when you’ve finished treatment?

How do you coordinate your ongoing care with your Primary Care doc?

How do you keep track of your medical records and get the right information to the right people about what you’ve been through?

Now we have some answers.

  • Debra Loacker, RN, will provide an overview of the valuable information provided in cancer treatment summary and the survivorship care plan. You will learn where to obtain a copy of your own treatment summary, and how your doctor can use it.
  • Patricia Read-Williams, MD, will share her perspective as a Primary Care Provider on the importance of these documents in the care provided to cancer survivors.

When:

6/21/12 , 6:45-8:30 p.m.

Where:

Gilda’s Club Seattle • 1400 Broadway, Seattle, WA 98122

Phone: 206.709.1400 • info@gildasclubseattle.org • www.gildasclubseattle.org


Gilda’s Club Seattle

Gilda’s Club is a non-profit group that provides meeting places where men, women and children living with cancer and their families and friends join with others to build emotional, social and educational support as a supplement to medical care.

The club’s services are free and include support and networking groups, lectures, workshops and social events in a nonresidential, homelike setting.

The club is named in honor of Gilda Susan Radner was an American comedienne and actress, best known for her years as a cast member of Saturday Night Live.

Radner, who died at 42 of ovarian cancer, helped raise the public’s awareness of the disease and the need for improved detection and treatment.

Lectures are held on Thursday evenings at Gilda’s Club, 1400 Broadway, Seattle.

Please RSVP to attend.

Refreshments served 6:45-7:00 pm

Lecture begins 7:00-8:30 pm

All lectures are open to the public. There is no cost to attend our lectures.

Please RSVP 24+ hours in advance to attend and pre-register for Noogieland childcare a minimum of 72 hours in advance.

When:

6/21/12 , 6:45-8:30 p.m.

Where:

Gilda’s Club Seattle • 1400 Broadway, Seattle, WA 98122

Phone: 206.709.1400 • info@gildasclubseattle.org • www.gildasclubseattle.org

 

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Swedish to open new Women’s Cancer Center

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Seattle’s Swedish Medical Center will open a new cancer center that will provide services tailored specifically for women — next Tuesday, June 5th.

The 23,600-square-foot True Family Women’s Cancer Center will occupy the fifth and sixth floor of the medical center’s Arnold Pavilion at 1221 Madison on Swedish’s First Hill campus.

The goal is to bring the Swedish physicians specializing in treating cancer in women into a single location to better coordinate care and to provide women cancer patients with a place where they can find all the services they need under one roof, said Dr. Patricia Dawson, the medical director of the new center and a breast surgeon with the Swedish Cancer Institute.

Although women and men have many of the same kinds of cancer, these cancers often have a different course in women and respond differently to treatment, said Dr. Dawson.

Women with cancer also often seek the kind of community and support services the new center hopes to offer, she said.

In addition to exam rooms, imaging services and procedure rooms, the new center will have support-group meeting rooms, counseling services and an educational resource center.

The facility’s decor and layout was designed to be both practical and “calming and restful” with the aim of enhancing both the quality of care and the quality of the patients’ experience, Dr. Dawson said.

The new center brings together a variety of clinicians and services that in the past have been scattered across the Swedish Medical Center’s main campuses.

Alexis Vanden Bos, a patient of Dr. Dawson who has been treated for two breast cancers, remembers having to shuttle between campuses during her treatments, often carrying her radiology films under her arm.

Alexis Vanden Bos

“It wasn’t bad, but how much easier this will be,” Vanden Bos said. “Now, I’ll be able to talk to both my surgeon and my oncologist in one place. I’ll love having all my people together.”

Construction of the $11 million facility was funded entirely from philanthropic gifts. The families of Patricia True, Doug and Janet True, and Bill and Ruth True began the fund-raising effort with $2 million donation.

Other major contributors include Eve and Chap Alvord, Robin Knepper, the Norcliffe Foundation, Bruce and Jeannie Nordstrom, Seattle Radiology, and Sellen Construction.

Additional support came from more that 2,500 individual donors.

The center’s staff will include oncologists, surgeons, onsite radiologists, psychological and genetic counselors, physical therapists, social workers and patient education specialists.

The center will provide resources for women with most cancers, including bladder, brain, breast, cervical, colorectal, esophageal, head and neck, leukemia, liver, lung, lymphoma, multiple myeloma, ovarian, pancreatic, renal/kidney, skin, thyroid and uterine.

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U.S. cancer deaths continue steady decline

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By Sharon Reynolds
NCI Cancer Bulletin Staff Writer 

According to the latest data on nationwide death rates from cancer, overall mortality from cancer declined from 1999 to 2008, maintaining a trend seen since the early 1990s.

Mortality fell for most cancer types, including the four most common types of cancer in the United States (lungcolorectalbreast, and prostate), although the rate of decline varied by cancer type and across racial and ethnic groups.

The complete Annual Report to the Nation on the Status of Cancer, 1975–2008 appeared March 28 in Cancer.

The declines in cancer death rates (mortality) averaged 1.7 percent per year for men and 1.3 percent per year for women from 1999 through 2008.

Among men, the overall rate of new cancer cases (incidence) fell by an average of 0.6 percent annually from 1999 to 2008.

Among women, incidence dropped by an average of 0.5 percent annually from 1999 to 2006 but held steady from 2006 to 2008.

Cancer incidence in children ages 0 to 14 rose from 1999 to 2008 (by 0.5 percent a year), continuing a trend seen in previous Annual Reports to the Nation.

However, advances in treatment contributed to a steady decline in mortality rates for children with cancer in the last 5 years (an average of 2.8 percent per year).

“Steady progress, as measured by declines in cancer death rates for many cancers, is good because we have an aging, growing population,” said Dr. Brenda K. Edwards, NCI’s senior advisor for surveillance.

“While the number of people diagnosed with cancer or who die of the disease may be increasing, the decline in cancer death rates for more than a decade is the best indicator of progress due to prevention, screening, diagnosis, and treatment,” she added.

NCI, the American Cancer Society, the Centers for Disease Control and Prevention (CDC), and the North American Association of Central Cancer Registries (NAACCR) collaborated on the report. Cancer incidence data came from NCI’s Surveillance, Epidemiology, and End Results (SEER) database and from the CDC, with analyses of pooled data by NAACCR. Mortality data came from the CDC’s National Center for Health Statistics.

Not All Good News

There were some notable exceptions to the overall decreases in incidence and mortality. From 1999 to 2008, death rates rose for pancreatic cancer in men and women, for liver cancer and melanoma in men, and for endometrial cancer in women.

The cervical cancer death rate, which had been falling for decades, showed no further decrease over the last 5 years.

And, although incidence rates fell overall for men and women from 1999 to 2008, the decline was not distributed evenly across racial and ethnic groups.

Cancer incidence rates did not decrease significantly among American Indian/Alaska Native men and women combined or among black, Asian and Pacific Islander, and American Indian/Alaska Native women.

Although incidence rates in black men did decline, this group still had the highest cancer incidence rate of any racial and ethnic group, 15 percent higher than that of white men and nearly double that of Asian and Pacific Islander men.

Major Modifiable Risk Factors

Each Annual Report to the Nation includes a special feature that focuses on a topic of importance to the cancer research community and the public.

This year’s report featured an analysis on the contribution of excess weight (overweight and obesity) and insufficient physical activity to the nation’s cancer burden.

More than 60 percent of the U.S. adult population is estimated to be overweight or obese, and a similar percentage of adults do not get the recommended amount of physical activity.

The rates of insufficient physical activity are even worse for children; for example, up to 90 percent of high school girls do not engage in recommended levels of physical activity.

Excess weight “is a major modifiable risk factor for cancer and other diseases—probably second only to tobacco use in terms of its impact on cancer incidence and mortality,” said Dr. Edwards. “The risk may be modest but it’s so pervasive that we felt this was the time to look at [cancer] incidence in this context.” Physical inactivity not only contributes to excess weight but is itself a risk factor for several cancer types.

The report was not designed to quantitatively link the trends in excess weight and lack of physical activity to the national trends for cancer, explained Dr. Rachel Ballard-Barbash, associate director of the Applied Research Program in NCI’s Division of Cancer Control and Population Sciences.

Many other studies have shown convincing links between excess weight and several cancer types, including endometrial, postmenopausal breast, colorectal, kidneyesophageal, and pancreatic cancer.

The point of the special feature, she noted, “is to highlight specific types of cancer that are related to [excess weight and lack of sufficient physical activity], show how these behaviors relate to these cancers in terms of their relative risks, and briefly describe some of the mechanisms by which they relate.”

The special feature also highlights national- and state-level prevention strategies in policy and environmental change that are intended to help people achieve recommended changes in their diets and physical activity levels.

As the nation’s weight has risen, so has the incidence of some, although not all, types of cancer related to excess weight and lack of sufficient physical activity. From 1999 to 2008, incidence rates of kidney cancer and of adenocarcinoma of the esophagus each rose about 3 percent per year for men and women, while incidence of pancreatic cancer rose 1.2 percent per year among men and women.

In addition, incidence rates of endometrial cancer rose significantly among black, Asian and Pacific Islander, and Hispanic women. Incidence of postmenopausal breast cancer stabilized from 2005 to 2008, after a period of decline.

“Although all of these cancers are influenced by multiple factors, the high prevalence of excess weight and insufficient physical activity likely contributed to these observed increases and to the lack of decline in breast cancer,” the authors wrote. “Continued progress in reducing cancer incidence and mortality rates will be difficult without success in promoting healthy weight and physical activity, particularly among youth.”

Excess weight and lack of physical activity also influence cancer survivorship, explained Dr. Ballard-Barbash, as both can negatively affect outcomes after a cancer diagnosis, further increasing the need for these risk factors to be addressed on a personal and societal level.

The NCI Cancer Bulletin is an award-winning biweekly online newsletter designed to provide useful, timely information about cancer research to the cancer community. The newsletter is published approximately 24 times per year by the National Cancer Institute (NCI), with day-to-day operational oversight conducted by federal and contract staff in the NCI Office of Communications and Education. The material is entirely in the public domain and can be repurposed or reproduced without permission. Citation of the source is appreciated.

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PATH names Steve Davis president and CEO

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Davis

Seattle’s global health organization PATH announced today that Steve Davis has been appointed president and CEO.

In his new position Davis will oversee PATH’s annual budget of $305 million, a staff of nearly 1,200, and a portfolio of projects based in PATH offices in 22 countries.

PATH projects include the development of an affordable meningitis vaccine, improved screening and treatment for HIV/AIDS and tuberculosis, and low-cost filters for safe drinking water.

Davis comes to PATH  from McKinsey & Company, where he was global director of social innovation.

In that position, Davis led a global team that consults for nongovernmental organizations (NGOs), governments, and the private sector, with a focus on global health and development, research and development, and Asia and Africa.

Previously, Davis was a long-term CEO of Corbis, a global digital media leader, and served as interim CEO of the Infectious Disease Research Institute, a nonprofit biotech working on vaccines, diagnostics, and drug discovery for infectious diseases of poverty.

His previous experiences also include serving as interim director of PATH’s India program, practicing law with K&L Gates, and working on refugee and human rights issues.

Mr. Davis earned his bachelor’s degree from Princeton University, his master’s degree from the University of Washington, and his juris doctor from Columbia University.

Davis will join PATH on June 11 and be based at PATH’s Seattle headquarters.

He succeeds former president and CEO Dr. Christopher J. Elias, who led PATH through significant growth for ten years.

Dr. Elias left PATH in January to become president of the Global Development Program at the Bill & Melinda Gates Foundation.

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Cytological specimen showing cervical cancer specifically squamous cell carcinoma in the cervix. Tissue is stained with Pap stain and magnified x200. PHOTO courtesy of NCI

U.S. doctors overuse Pap smears — study

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By Milly Dawson, Contributing Writer
Health Behavior News Service 

A new study finds U.S. physicians are performing Pap smears far more often than needed to prevent cervical cancer.

The study, published in The Milbank Quarterly, examines Pap smear usage alongside cervical cancer mortality data in the U.S. and the Netherlands between 1970 and 2007.

Cytological specimen showing cervical cancer specifically squamous cell carcinoma in the cervix. Tissue is stained with Pap stain and magnified x200. PHOTO courtesy of NCI

Cytological specimen showing cervical cancer specifically squamous cell carcinoma in the cervix. Tissue is stained with Pap stain and magnified x200. PHOTO courtesy of NCI

While American doctors performed about three or four times as many Pap smears as Dutch doctors did, the rates at which women developed or died from cervical cancer were roughly equal for the two nations.

“This strongly suggests that the Dutch approach to cervical cancer screening is much more efficient than the U.S. approach. We did detect some potential shortcomings in the Dutch approach, but the evidence suggests that the U.S. could move substantially in the direction of the Dutch program, at considerable economic savings, without sacrificing health benefits,” said co-author Martin L. Brown, Ph.D., of the National Cancer Institute.

KEY POINTS

  • In the U.S., women received three to four times the number of Pap smears over a period of three decades as women in the Netherlands, yet the two countries’ cervical cancer mortality rates were similar.
  • The Netherlands follows a model of screening based on governmental guidelines; the U.S. has traditionally followed a model based on decisions by individual physicians, insurance plans and guidelines from medical organizations.

The Netherlands has long treated cancer screening as a national public health endeavor carried out by doctors who generally follow National Ministry of Health guidelines, the study reports.

Meanwhile, the U.S. follows a medical model: individual doctors choose who to screen and how often. U.S. doctors select from or ignore guidelines from various organizations and from the government’s U.S. Public Health Service.

Overall, in the Netherlands, cancer screenings adhere to the most recent evidence. There, a woman generally undergoes a lifetime total of 7 Pap smears between ages 30 and 60. Doctors typically screen patients every five years, depending on their age and risk level.

“In the U.S., actual medical practice lags behind and diverges strongly from evidence-based guidelines,” says Brown. Screening guidelines U.S. doctors adopt from highly influential medical societies vary widely, calling for anywhere from 20 to 33 Pap smears. Screenings often take place annually, without regard for a woman’s age or risk.

While the study discussed only cervical cancer evidence, the authors did note that its themes might apply to differences in screening for many preventable diseases.

Darcy Phelan, DrPH with the Johns Hopkins Bloomberg School of Public Health, hopes that policy makers will consider these findings as they address ways of preventing cervical cancer that are more efficient. “These findings suggest that broad adoption of a policy to extend the Pap screening interval will protect patient safety while reducing costs. This will be especially important as prevention costs escalate in the context of human papillomavirus (HPV) vaccination among girls and young women.”

Both experts noted that the U.S. Preventive Services Task Force included extension of the interval in its recently updated cervical cancer screening guidelines.

Phelan added that the study confirms the importance of screening all women, as most cervical cancers occur among those never screened or not screened within the recommended interval.

Screening all women has great potential to reduce persistent racial and ethnic disparities in cervical cancer in the U.S., she says.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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How mothers-to-be can avoid toxins that affect fetal development.

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Mothers-to-be can reduce the risk their children will be be harmed by environmental toxins by takings simple steps to avoid exposure to certain chemicals before they conceive and during their pregnancies, according to new guidelines drawn up by a research team led by Seattle pediatrician and environmental health expert Dr. Sheela Sathyanarayana of Seattle Children’s Research Institute.

The guidelines, which were published online this week by the  American Journal of Obstetrics & Gynecology, were written to help health-care providers counsel mothers-to-be on how to avoid such toxins as lead, mercury, and a class of chemicals called “endocrine disrupters” that resemble hormones and have been linked to a number health problems including reproductive tract and neurodevelopment abnormalities.

Although the guidelines were written for health-care providers, the guidelines contain helpful information for patients, too, says Dr. Sathyanarayana.

“There are simple ways to reduce exposures to lead, mercury, pesticides and endocrine-disrupting chemicals . . .  by following the guidelines we have outlined,” Dr. Sathyanarayana said.

“Women and their partners should be aware that pregnancy is an important time for development, that environmental chemicals can cause harm to a developing fetus, and that this topic is important to discuss with health care providers,” said Dr. Sathyanarayana.

A summary of the guidelines provided by Seattle Children’s Research Institute is below:

Environmental Exposures:  

Tips for Reproductive Health Care Providers, Preconception and Prenatal Women

Mercury

  • Risk factors: Exposure can come from eating fish, contact with quicksilver, and use of skin-lightening creams.  Exposure during pregnancy can lead to adverse neurodevelopmental outcomes that include lower IQ, poor language and motor development
  • Reducing exposure to mercury:  Pregnant, preconception and breastfeeding women should follow U.S. Environmental Protection Agencyand state-specific fish consumption guidelines.  Avoid shark, swordfish, king mackerel, tile fish and large tuna.
  • Resources:  Fish Chart and mercury guide.

Lead

  • Risk factors: Risk factors for exposure include recent immigration to the U.S., occupational exposure, imported cosmetics, and renovating or remodeling a home built before 1970.  Lead is neurotoxic to a developing fetus.
  • Reducing exposure:  Never eat nonfood items (clay, soil, pottery or paint chips); avoid jobs or hobbies that may involve lead exposure; stay away from repair, repainting, renovation and remodeling work conducted in homes built before 1978; eat a balanced diet with adequate intakes of iron and calcium; avoid cosmetics, food additives and medicines imported from overseas; and remove shoes at the door to prevent tracking in lead and other pollutants.
  • Resources: Lead in Pregnancy/CDC and Poison Center Locator.

Pesticides

  • Risk factors: Exposure can come from eating some produce and from using pesticides in your home or on your pets.  Exposure to pesticides in pregnancy has been shown to increase risk of intrauterine growth retardation, congenital anomalies, leukemia and poor performance on neurodevelopmental testing.
  • Reducing exposure:  Do not use chemical tick and flea collars or dips; avoid application of pesticides indoors and outdoors; consider buying organic produce when possible; wash all fruits and vegetables before eating; and remove shoes at the door.
  • Resources:  http://www.ewg.org/foodnews (focus on the “Dirty Dozen,” a list of the 12 most contaminated products published by the Environmental Working Group.

Endocrine-disrupting chemicals

  • Risk factors: Human prenatal phthalate exposure is associated with changes in male reproductive anatomy and behavioral changes primarily in young girls. Animal studies suggest prenatal exposure to BPA is associated with obesity, reproductive abnormalities and neurodevelopmental abnormalities in offspring. Endocrine-disrupting chemicals mimic or antagonize the effects of hormones in the endocrine system and can cause adverse health effects that can be passed on to future generations.
  • Reducing exposure:  Decrease consumption of processed foods; increase fresh and/or frozen foods; reduce consumption of canned foods;  avoid use of plastics with recycled codes #3, #6 and #7; be careful when removing old carpet because padding may contain chemicals; and use a vacuum machine fitted with a HEPA filter to get rid of dust that may contain chemicals.
  • Resources:  BPA, CDC, and EPA.
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Safe

Texting sex ed – NYTs

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The New York Times’s Jan Hoffman reports on efforts by health organizations and school districts to develop Web sites and texting services to provide teens with accurate information about sex.

Supporters of the initiatives say these new services allow students to get good information about sex anonymously. But there are also those who oppose these initiatives, writes Hoffman.

…proponents of abstinence-based sexual education argue that these digital services presume that sexual activity among teenagers is the norm, and do not spend enough time on alternatives.

“They are only focusing on the risk-reduction model,” said Valerie Huber, executive director of the National Abstinence Education Association, which hopes to kick off its online service for teenagers next year.

Those who run digital programs say they simply want teens to have accurate information, to help them make good decisions. Even though popular culture is saturated with sex, facts and advice can be hard to find.

To learn more:

Some of the services discussed:

 

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